Provider Demographics
NPI:1780033423
Name:RETINA OF AUBURN & METRO-COLUMBUS
Entity Type:Organization
Organization Name:RETINA OF AUBURN & METRO-COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDDADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-797-2666
Mailing Address - Street 1:1240 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2954
Mailing Address - Country:US
Mailing Address - Phone:307-797-2666
Mailing Address - Fax:
Practice Address - Street 1:1240 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2954
Practice Address - Country:US
Practice Address - Phone:307-797-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067153207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty